Acid Reflux & GERD: The Unsettling Reality in Canada
The Canadian Society of Intestinal Research and our new national partner charity, the Gastrointestinal Society, have collaborated with Association des Maladies Gastro-intestinales Fonctionnelles and the Canadian Digestive Health Foundation to produce a health report card called, Acid Reflux & GERD: The Unsettling Reality in Canada. Here we’re offering some highlights of this new, compelling document.
ARD & GERD are debilitating conditions that affect millions of Canadians
Imagine a burning pain behind the breastbone, which creeps upward toward the throat, coupled with regurgitation and an acidic taste in the mouth. These are symptoms of acid-related diseases (ARDs), including gastroesophageal reflux disease (GERD), and they worsen after common, everyday happenings, such as eating, bending over, lying down, or certain physical activities. These symptoms are due to a reverse flow of stomach contents up into the esophagus.
GERD is a condition involving acid regurgitation/reflux, and it’s one type of ARD in which heartburn, ranging from mild to severe, is the most common symptom. Acid reflux may also trigger persistent hoarseness, difficult or painful swallowing, asthma, unexplained chest pain, bad breath, and the feeling of a lump in the throat. Furthermore, reflux can affect the throat with symptoms such as voice loss and soreness, as well as the airways with chronic coughing, wheezing, or episodic choking attacks.
Individuals with GERD incur significant personal expenses to manage their illness.
Population-based studies reveal that GERD is a common condition with a prevalence of 10-20% in North America.4 In
Canada, GERD is the most prevalent acid-related disorder.5 Approximately 13% of Canadians suffer from GERD symptoms weekly.5 Almost one quarter of the population (24%) experiences heartburn daily or more frequently.2
GERD decreases quality of life
GERD is often a misunderstood condition, and its potential severity is not fully recognized by the general public, patients, the healthcare system and, in some cases, healthcare providers. It markedly affects patients’ health-related quality of life and daily activities.6
For example, a study of more than 6,000 GERD patients demonstrated that the quality of life of individuals with reflux disease was significantly lower than that of the general population.3 In fact, the quality of life of GERD patients is similar to that of patients who have suffered from acute coronary events.3
Unmanaged severe GERD can damage the lining of the esophagus, which may be further complicated by bleeding or ulceration. Resultant chronic scarring may lead to narrowing of the esophagus, making swallowing difficult. Some patients may develop Barrett’s esophagus, a condition in which cells in the esophageal lining take on an abnormal appearance. Although rare, Barrett’s esophagus may increase the chance of developing esophageal cancer, which can be fatal.7
ARD/GERD patients self-medicate and wait too long before seeking medical attention
The vast majority (75%) of sufferers self-medicate and never see a physician.8 Because patients with ARD often misattribute the blame for their condition to their lifestyle choices, they delay seeking medical attention and getting appropriate medication. For example, patients will alter their diet, social life, work and daily activities to try to compensate for the symptoms they’re experiencing.
- Almost one-third of patients don’t consult a physician because they believe the symptoms are due to food choices.1
- Another one-quarter feel that their symptoms are due to their physical condition.1 Increasing frequency of symptoms is the primary driver cited as to why a person finally consults a physician.
- Many who have an acid-related disease, such as GERD, wait an average of over two years before talking with their physician about their problem.1
The clinical evidence reveals that lifestyle changes usually have only limited effect, and lifestyle modifications are not recommended as the sole management modality of GERD. Instead, pharmacological treatment is required to heal erosive esophagitis, and achieve and maintain effective symptom resolution.9
This highlights the need to educate people about this chronic condition, to help ensure those who suffer have access to information and to encourage people to seek the appropriate treatment.
Before seeking medical attention and targeted prescription medication, people with ARD experience severe symptoms
Patients experience numerous troublesome symptoms (including heartburn, acidic taste, stomach pain, indigestion, and sleeping problems) prior to taking medication.1 In fact, approximately 80% of people with an ARD experienced at least one somewhat to very severe symptom prior to receiving a prescription medication.1 Furthermore, two in five patients (41%) have difficulty sleeping, with 43% feeling tired and/or worn out.1
Often unrecognized, sleeping problems have a significant impact on workplace productivity, as this means increased time off work (7% missed work) and decreased concentration at work (experienced by 18%) for those with ARD.1 >Ultimately, this issue can have serious cost implications, affecting the bottom line for Canadian employers, employees and government.
Drug coverage limitations are a barrier to effective treatment
There is a lack of universal coverage for prescription medications in the treatment of ARD and ARD-like symptoms. Drug coverage limitation is a major barrier to the effective treatment of GERD. This issue must be addressed in order to help avoid escalation of disease symptoms.
The level of prescription drug coverage varies by province and in federally funded plans. Quebec is the only province with open access to all medications available for ARD; therefore, the people of Quebec are less likely to rely on over-the-counter medications (in addition to their prescription medication) for ARD management when compared to people in other provinces.1 Additionally, those in Quebec also report that their ARD symptoms have less interference with their daily lives compared to persons with ARD living throughout the rest of Canada.1 This suggests that proper management of the disease can improve quality of life.
Dialogue necessary to tailor appropriate therapy
In Canada, there are three primary methods generally employed for the treatment of GERD:
- Lifestyle and Dietary Modifications, these are appropriate steps, and must be made in consultation with a healthcare professional, however, these alone will not usually alleviate the symptoms of a chronic GERD sufferer; 8
- Over-the-Counter (OTC) Medications, such as antacids and lower-dose histamine-2 receptor antagonists (H2RAs), are non-prescription medications used to treat GERD symptoms, and
- Prescription Medications, two classes of prescription medications used to help suppress acid secretion are higher-dose H2RAs and proton pump inhibitors (PPIs).
Available evidence indicates that therapy response rates in GERD are related to the degree of acid suppression achieved.1 Having an appropriate discussion with a physician is the key to understanding the condition, available treatment options, and the degree to which acid suppression can be achieved. For example, the PASS Test is a useful tool to build dialogue between physicians and their GERD patients on PPIs (one class of prescription medications used to treat these conditions).
No matter what therapy, both the patient and the physician should proactively engage and participate in a GERD management discussion with constant re-evaluation at all stages of treatment to ensure optimal disease management and assess the advantages and disadvantages of all options, including factors such as lifestyle, diet, family history, treatment choices and patient compliance.
Please contact our office if you would like a copy of the full report. We thank AstraZeneca Canada for providing resources and support toward this initiative.
- Two in five patients with GERD have difficulty sleeping, and 43% feel tired and/or worn out1
- Quality of life of GERD patients is similar to that of patients who have suffered from acute coronary events3
- On average, ARD patients wait over 2 years before seeking care1
- Almost one-third of GERD patients don’t consult a physician because they believe symptoms are due to food choices1
The PASS Test,° a simple, validated, 5-point questionnaire, may be helpful in identifying patients with persistent symptoms who may respond to a change in PPI therapy.
- Are you still experiencing stomach symptoms?
- In addition to your main medication, are you taking any of the following medications to control your symptoms: antacids, H2RAs, motility drugs, or others?
- Is your sleep affected by your stomach symptoms?
- Are your eating and drinking habits affected by your stomach symptoms?
- At any time, do your stomach symptoms interfere with your daily activities?11
° Proton pump inhibitor Acid Suppression Symptom (PASS)
First published in The Inside Tract® Newsletter Issue 170 Winter 2009
1. The acid related disease patient experience: Canada. Harris Interactive research report, AstraZeneca Canada, Association des maladies gastro-intestinales fonctionnelles, Canadian Digestive Health Foundation, Canadian Society of Intestinal Research, Gastrointestinal Society. September 2007.
2. Tytgat GN, McColl K, Tack J et al. New algorithm for the treatment of gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2008;27(3):249-56.
3. Kulig M, Leodolter A, Vieth M et al. Quality of life in relation to symptoms in patients with gastro-oesophageal reflux disease – an analysis based on the ProGERD initiative. Aliment Pharmacol Ther 2003 August:767-76.
4. Vakil N, Veldhuyzen van Zanten S, Kahrilas P et al. Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006;101:1900-20.
5. Armstrong D, Marshall JK, Chiba N et al. Canadian Consensus Conference on the management of gastroesophageal reflux disease in adults – update 2004. Can J Gastroenterol 2005;19(1):15-35.
6. Johnson DA. GERD and quality of life. Journal watch. Available from: http://gastroenterology.jwatch.org/cgi/content/full/2006/804/1. Accessed June 2008.
7. Canadian Society of Intestinal Research. Gastro esophageal reflux disease. Available from www.badgut.org. Accessed June 2008.
8. Ferguson H, Johnston BT. Epidemiology and quality of life concerns in gastroesophageal reflux disease. Pract Gastroenterol 2004 April:62-9.
9. Nocon M, Labenz J, Jaspersen D et al. Long-term treatment of patients with gastro-oesphageal reflux disease in routine care – results from the ProGERD study. Aliment Pharmacol Ther 2007 January:715-22.
10. Katz PO, Ginsberg GG, Hoyle PE et al. Relationship between intragastric acid control and healing status in the treatment of moderate to severe erosive oesophagitis. Aliment Pharmacol Ther 2007;25:617-28.
11. Armstrong D, Veldhuyzen SJ, Chung SA et al. Validation of a short questionnaire in English and French for use in patients with persistent upper gastrointestinal symptoms despite proton pump inhibitor therapy: the PASS (Proton pump inhibitor Acid Suppression Symptom) Test. Can J Gastroenterol 2005;19:350-8.